According to the Centers for Disease Control, the ICD-10-CM "is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States." These codes are used in billing and reimbursement for medical diagnoses and procedures.

Cold laser or Low-Level Laser Therapy (LLTT) is used to treat a variety of medical conditions. The following list of diagnoses may be appropriate for cold laser therapy. Please consult your doctor or the ICD-10-CM TABULAR LIST of DISEASES and INJURIES available on cdc.gov.

Suggested Clinical Uses for Cold Laser Therapy:

INFLAMMATORY CONDITIONS

Rheumatoid Arthritis

Epicondylitis

Carpal Tunnel Syndrome

Bursitis

Plantar Fasciitis

Primary Diagnosis

Pain

Restricted range of movement/stiffness

Edema

Effusion

Paresthesia

Inflammation

Adicular pain

Muscle spasms

Myofasciitis

PAIN MANAGEMENT

Fibromyalgia

Bursitis

Lower back pain

Myofascial pain

Fasciitis

Neck/Cervical pain

Primary Diagnosis

Pain

Restricted range of motion/stiffness

Inflammation

Effusion

Edema

Muscle spasms

Mysofasciitis

CONNECTIVE TISSUE INJURY

Tendonitis

Tendon ruptures

Sprains

Strains

Primary Diagnosis

Pain

Inflammation

Restricted range of motion/stiffness

Effusion

Edema

Muscle spasms

Myofasciitis

Radicular pain

JOINT INJURY

Temporomandibular (TM) disorders

Ligament injury

Dislocations

Osteoarthritis

Primary Diagnosis

Joint pain

Inflammation

Restricted range of motion/stiffness

Joint effusion

Edema

MUSCLE INJURY

Muscle bruises/contusions

Muscle contractures

Muscle ruptures

Myositis

Primary Diagnosis

Muscle Pain

Inflammation

Restricted range of motion/stiffness

Muscle spasms

Edema

Myofasciitis

NEUROLOGICAL INJURY

Ruptured disc

Prolapsed disc

Crush injuries

Neuritis

Primary Diagnosis

Radicular pain

Myofasciitis

Decreased range of motion/stiffness

Inflammation

Muscle spasms

Paresthesia

Edema

Effusion

SKIN INJURIES AND CONDITIONS

Burns

Skin ulcers

Skin grafts

Surgical incisions

Primary Diagnosis

Joint pain

Inflammation

Restricted range of motion/stiffness

Edema

Current Procedural Terminology:

The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association and is "the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs."

After a diagnosis is made and an appropriate code is assigned (see above), insurance billing is made under a particular CPT code.

Because cold laser or LLLT does not have its own CPT codes, the following codes are being used for reimbursement:

For billing, this code should be accompanied by a one-page description of the treatment and the therapy. Otherwise, it may be denied. When you submit the code, try this: "97039 Attended FDA cleared infrared laser therapy." 97140 Manual Therapy Techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction); one or more regions; each 15 minutes. This billing code is used for what you are doing and/or accomplishing, not the technique used (i.e. laser). If an insurance carrier requires documentation, state what area was treated and what was accomplished (i.e. drainage, mobilization, etc.).

97026 Infrared

This code refers to an infrared heat lamp, but cold lasers are not infrared heating devices. Consequently, reimbursement can be low. To improve reimbursement, list as an attended modality or by adding a -22. Here are some examples:

97026: Attended photonic simulation

97026: Attended infrared light therapy

97026--22: Attended infrared therapy

97032 Attended Electrical Stimulation; manual; one or more regions; each 15 minutes

This code can be billed in a number of ways. The code (97032) stays the same, but the description changes to reflect the service performed. For example:

97032: Attended Electrical-Photonic Stimulation

97032: Attended Electrotherapy/IR

97032: FDA-Cleared Laser Photonic Stimulation

97139 Unlisted Therapeutic Procedure
This code is for a therapeutic procedure meaning that the doctor must have one-on-one contact with the patient. The strength of the code is that it tells the insurance carrier that the doctor is spending direct treatment time with the patient. The weakness of the code is that an unlisted procedure is more likely to be closely inspected by an insurance carrier.

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